Skip to content
How It Works
Explore
Ask a Question Resources Pricing
Who It's For
Patients
Decode results, prep for appointments, weigh options.
Caregivers & advocates
Carry the research load for someone you love.
Providers & clinicians
Resources for patients in your practice.
Log In Ask a Question
PubMed This is a summary of 19 peer-reviewed journal articles Updated
Ophthalmology

Treatments and Medication Strategy

At a Glance

Scleritis treatment depends on severity and cause: mild cases may start with oral NSAIDs, while more severe or recurrent disease may need steroids, immune-modulating drugs, or biologics. Surgery is reserved for threatened structural failure, and infection must be ruled out before immunosuppression.

The treatment of scleritis is a marathon, not a sprint. Because this condition involves deep-seated inflammation that can damage the eye’s structure, the goal of treatment is twofold: to stop the inflammation and to prevent it from coming back over the long term. This typically requires an individualized, stepped approach to medication [1][2].

The First Line: Rapid Control

When you are first diagnosed, the priority is to quiet the inflammation safely.

  • NSAIDs: Mild, non-necrotizing cases are often managed initially with a high-dose oral nonsteroidal anti-inflammatory drug. Safety context: NSAIDs require monitoring for gastrointestinal upset, blood pressure changes, and kidney function [1].
  • Systemic Corticosteroids: Moderate or severe patients often require oral prednisone or, in severe systemic cases, intravenous (IV) methylprednisolone [1][3]. While steroids work quickly to reduce pain and swelling, they are not a long-term solution due to side effects like bone thinning, weight gain, and increased eye pressure [4]. Crucial Rule: Never start, stop, or taper steroids without the direction of your treating clinician.
  • A Critical Warning: Clinicians will assess for infection before starting immunosuppression. If an infection is present, steroids can accidentally “fuel” the germs by suppressing your immune system’s ability to fight back, leading to rapid tissue destruction [5][6].

The Second Line: Steroid-Sparing Therapy

If your scleritis is severe, necrotizing, or returns whenever you try to lower your steroid dose, your doctor may introduce Immunomodulatory Therapy (IMT) [4][1]. These are “steroid-sparing” drugs that allow you to taper off prednisone while keeping the immune system in check.

Commonly used IMT agents include:

  • Methotrexate: A commonly used option that has shown success in controlling inflammation in many patients over time [7].
  • Mycophenolate Mofetil (CellCept) and Azathioprine: Effective alternatives that help stabilize the immune system over months [3][8].
  • Cyclophosphamide: A much stronger medication reserved for the most severe, life-threatening cases associated with systemic vasculitis (like GPA) [3][9].

Safety Context: These medications require regular, drug-specific blood tests for liver and kidney function, as well as infection precautions and discussions regarding pregnancy, fertility, and vaccinations.

Advanced Options: Biologics

For cases that do not respond to traditional IMT (known as “refractory” scleritis), doctors may turn to biologic therapies. These are advanced medications that target specific parts of the immune system.

  • Rituximab: This drug targets B-cells and has shown success in treating difficult scleritis cases, with some patients achieving remission [10].
  • Anti-TNF Agents (e.g., Infliximab, Adalimumab): These block a specific inflammatory protein (TNF) and are effective at reducing relapses and the need for steroids [11][12].
  • Safety Screening: Before starting a biologic, you will need screening for tuberculosis (TB) and other latent infections, as these drugs can cause them to reactivate [13][14].

When is Surgery Necessary?

Surgery is generally not used to “cure” scleritis, but rather as a tectonic measure to save the eye if the tissue threatens structural failure [15].

  • Scleral Patch Graft: If necrotizing scleritis leads to extreme thinning or a “melt,” a surgeon may perform a tectonic graft [16]. They use donor tissue (sclera, cornea, or even pericardium) to patch the thin area and prevent perforation (a hole in the eye globe) [17][18].
  • Surgical Debridement: In cases of infectious scleritis, a surgeon may need to physically remove infected or dead tissue so that antimicrobial drops can reach the area more effectively [15][19].

In autoimmune cases, patch grafting is planned alongside control of active inflammation, while infectious cases require culture-directed antimicrobial therapy, not automatic immunosuppression [16][17].

Common questions in this guide

What treatment is usually started for scleritis?
Mild, non-necrotizing scleritis is often treated first with a high-dose oral nonsteroidal anti-inflammatory drug (NSAID). Moderate or severe disease may require oral prednisone, and very severe systemic cases may need intravenous methylprednisolone. The choice depends on the severity and cause of the inflammation.
Why do doctors check for infection before treating scleritis with steroids?
Steroids and other immune-suppressing medicines can weaken the body's ability to control an infection. If infectious scleritis is present, immunosuppression can allow the infection to worsen and damage the eye quickly. Infectious cases need appropriate antimicrobial treatment, often guided by testing.
When are steroid-sparing medicines used for scleritis?
Immune-modulating medicines may be added when scleritis is severe, necrotizing, or returns as the steroid dose is lowered. Options include methotrexate, mycophenolate mofetil, azathioprine, and, for the most severe cases associated with systemic vasculitis, cyclophosphamide. These medicines can take months to stabilize inflammation and require regular blood-test monitoring.
Can biologic medicines help if scleritis does not respond to other treatment?
Biologic medicines may be considered for refractory scleritis that does not respond adequately to traditional immune-modulating therapy. Examples include rituximab and anti-TNF medicines such as infliximab or adalimumab. Screening for tuberculosis and other hidden infections is needed before treatment because biologics can allow infections to reactivate.
What monitoring is needed while taking scleritis medicines?
NSAIDs may require monitoring for stomach problems, blood pressure changes, and kidney function. Immune-modulating medicines generally require blood tests for liver and kidney function, along with infection precautions and discussions about pregnancy, fertility, and vaccinations. Biologic treatment also requires screening for tuberculosis and other latent infections.
When is surgery needed for scleritis?
Surgery is usually not used to cure scleritis, but it may be needed when severe thinning or tissue loss threatens the eye's structure. A tectonic graft can patch the weak area and help prevent a hole in the eye, while infectious scleritis may require removal of infected or dead tissue. Autoimmune inflammation still needs medical control, and infectious cases need antimicrobial treatment.
How should I handle a steroid taper for scleritis?
Follow the taper plan prescribed by your clinician and never start, stop, or change the dose on your own. If pain returns while the dose is being lowered, contact your care team promptly and follow your individualized flare plan. A steroid-sparing medicine may be considered when inflammation returns during tapering.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Do we have a definitive plan for my 'steroid taper,' and at what point will we introduce a steroid-sparing medication?
  2. 2.Which specific immunomodulatory therapy (IMT) do you recommend for me, and why is it the best fit for my subtype of scleritis?
  3. 3.If my current treatment fails, would I be a candidate for biologic therapies like Rituximab or an Anti-TNF agent?
  4. 4.What baseline tests (such as TB screening or liver function) do I need before starting these systemic medications?
  5. 5.What specific signs of structural thinning would prompt a discussion about surgical patch grafting?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References

References (19)
  1. 1

    Current Approach for the Diagnosis and Management of Noninfective Scleritis.

    Dutta Majumder P, Agrawal R, McCluskey P, Biswas J

    Asia-Pacific journal of ophthalmology (Philadelphia, Pa.) 2020; (10(2)):212-223 doi:10.1097/APO.0000000000000341.

    PMID: 33290287
  2. 2

    Patterns of Non-Infectious Scleritis across a Tertiary Eye Care Network Using the Indigenously Developed Electronic Medical Record System-eyeSmart.

    Murthy SI, Das AV, Kammari P, et al.

    Ocular immunology and inflammation 2022; (30(7-8)):1733-1739 doi:10.1080/09273948.2021.1942497.

    PMID: 34255594
  3. 3

    Management of noninfectious scleritis.

    Abdel-Aty A, Gupta A, Del Priore L, Kombo N

    Therapeutic advances in ophthalmology 2022; (14()):25158414211070879 doi:10.1177/25158414211070879.

    PMID: 35083421
  4. 4

    Clinical characteristics and efficacy of methotrexate in Japanese patients with noninfectious scleritis.

    Hiyama T, Harada Y, Kiuchi Y

    Japanese journal of ophthalmology 2021; (65(1)):97-106 doi:10.1007/s10384-020-00778-5.

    PMID: 33107015
  5. 5

    Infectious Scleritis: Pathophysiology, Diagnosis, and Management.

    Yu J, Syed ZA, Rapuano CJ

    Eye & contact lens 2021; (47(8)):434-441 doi:10.1097/ICL.0000000000000813.

    PMID: 34224444
  6. 6

    Scleritis: Differentiating infectious from non-infectious entities.

    Murthy SI, Sabhapandit S, Balamurugan S, et al.

    Indian journal of ophthalmology 2020; (68(9)):1818-1828 doi:10.4103/ijo.IJO_2032_20.

    PMID: 32823398
  7. 7

    Methotrexate for the treatment of noninfectious scleritis.

    Sands DS, Chan SCY, Gottlieb CC

    Canadian journal of ophthalmology. Journal canadien d'ophtalmologie 2018; (53(4)):349-353 doi:10.1016/j.jcjo.2017.11.009.

    PMID: 30119788
  8. 8

    Scleritis associated with relapsing polychondritis.

    Sainz-de-la-Maza M, Molina N, Gonzalez-Gonzalez LA, et al.

    The British journal of ophthalmology 2016; (100(9)):1290-4 doi:10.1136/bjophthalmol-2015-306902.

    PMID: 26888976
  9. 9

    Ocular complications and mortality in peripheral ulcerative keratitis and necrotising scleritis: The role of systemic immunosuppression.

    Ogra S, Sims JL, McGhee CNJ, Niederer RL

    Clinical & experimental ophthalmology 2020; (48(4)):434-441 doi:10.1111/ceo.13709.

    PMID: 31872475
  10. 10

    Rituximab in the Treatment of Refractory Noninfectious Scleritis.

    Cao JH, Oray M, Cocho L, Foster CS

    American journal of ophthalmology 2016; (164()):22-8.

    PMID: 26766304
  11. 11

    Biologic Therapies and Small Molecules for the Management of Non-Infectious Scleritis: A Narrative Review.

    Sota J, Girolamo MM, Frediani B, et al.

    Ophthalmology and therapy 2021; (10(4)):777-813 doi:10.1007/s40123-021-00393-8.

    PMID: 34476773
  12. 12

    Ocular Pharmacology for Scleritis: Review of Treatment and a Practical Perspective.

    Stem MS, Todorich B, Faia LJ

    Journal of ocular pharmacology and therapeutics : the official journal of the Association for Ocular Pharmacology and Therapeutics 2017; (33(4)):240-246 doi:10.1089/jop.2016.0127.

    PMID: 28355124
  13. 13

    Treatment of psoriasis with biologic and non-biologic targeted therapies in patients with latent tuberculosis infection or at risk for tuberculosis disease progression: Recommendations from a SPIN-FRT expert consensus.

    Torres T, Brembilla NC, Langley RG, et al.

    Journal of the European Academy of Dermatology and Venereology : JEADV 2025; (39(1)):52-69 doi:10.1111/jdv.20287.

    PMID: 39149807
  14. 14

    Biological agents and respiratory infections: Causative mechanisms and practice management.

    Takayanagi N

    Respiratory investigation 2015; (53(5)):185-200.

    PMID: 26344608
  15. 15

    Necrotizing Scleritis: A Review.

    Dutta Majumder P, Agarwal S, Shah M, et al.

    Ocular immunology and inflammation 2024; (32(7)):1405-1419 doi:10.1080/09273948.2023.2206898.

    PMID: 37279404
  16. 16

    Clinical Profile of Patients with Necrotizing Scleritis in a Tertiary Eye Care Center in Southern India.

    Dutta Majumder P, Ghose A, Chidambaram M, et al.

    Ocular immunology and inflammation 2018; (26(3)):412-416 doi:10.1080/09273948.2016.1223857.

    PMID: 27762661
  17. 17

    Clinical profile and management of granulomatosis with polyangiitis-associated scleritis from a tertiary care hospital in South India.

    Mohanan-Earatt A, Biswas J

    Indian journal of ophthalmology 2023; (71(1)):146-152 doi:10.4103/ijo.IJO_1411_22.

    PMID: 36588225
  18. 18

    Scleral Patch Graft With a Suture Reinforcement Technique in Surgical Management of Necrotizing Scleritis With Ectasia.

    Wen JC, Lam J, Banitt MR

    Cornea 2018; (37(7)):933-935 doi:10.1097/ICO.0000000000001598.

    PMID: 29664747
  19. 19

    Successful Ocular Structural Restoration of Aggressive Necrotizing Sclerouveitis Following Pterygium Excision: Infectious, Autoimmune, or Both?

    Santos CL, Chanthan D, El-Feky D, et al.

    Research square 2026; doi:10.21203/rs.3.rs-9954548/v1.

    PMID: 42396477

This page about scleritis treatment is for informational purposes only and does not constitute medical advice. Do not start, stop, or taper medicines without guidance from your treating clinician.

Get notified when new evidence is published on scleritis.

We monitor PubMed for new peer-reviewed studies on this topic and email a short summary when something meaningful changes.